Irritable Bowel Syndrome

Question 1

How is IBS classified?

Answer 1

• IBS w/ predominant constipation (IBS-C): Usually constipation
• IBS w/predominant diarrhea (IBS-D): Usually diarrhea (type 6 & 7 in the BSFS)
• IBS w/mixed bowel habits (IBS-M): Usually both constipation and diarrhea (> ¼ of were constipation and > ¼ were diarrhea)
• IBS unclassified (IBS-U): Meet diagnostic criteria for IBS but cannot be accurately categorized into one of the other three subtypes.

Question 2

What are the clinical manifestations of IBS?

Answer 2

Chronic abdominal pain – Colicky + Dyspepsia

• Cramping sensation with variable intensity and periodic exacerbations
• Associated with dyspepsia: bloating, belching, flatulence

Altered bowel habits – may be continuous / intermittent / alternating

• Diarrhoea
• Constipation
• Alternating diarrhea and constipation
• Normal bowel habits alternating with diarrhea and/or constipation

Question 3

What are the investigations performed for IBS?

Answer 3

Investigations:

• FBC
• CRP, fecal calprotectin
• Test for celiac disease: tTG IgG/ anti-endomysial IgA, IgA

Question 4

What is the ROME IV criteria used to diagnose IBS?

Answer 4

Recurrent abdominal pain, at least 1 day/week in the last 3 months

With 2 or more of the following criteria:

• Related to defecation: commonly reported to be relieved by defecation
• Associated with change in frequency of stool
• Associated with change in consistency of stool

Question 5

What is the conservative management of IBS?

Answer 5

Patient education 🡪 chronic dz, does not ↑ risk of cancer

Dietary modification

• Low FODMAP diet 🡪 to be initiated by trained nutritionist: Fermentable, Oligosaccharides, Disaccharides, Monosaccharides And Polyols
• Lactose avoidance
• Exclusion of gas producing foods
• Gluten avoidance
• Fibre (IBS-C)
• Traditional IBS diet 🡪 avoid large meals, reduce fats, reduce caffeine, reduce gas producing food e.g. beans, cabbage, onion

Regular physical activity

Question 6

What is the pharmacological management of IBS-D?

Answer 6

Anti-diarrhoeal agents: loperamide, eluxadoline

Question 7

What is the pharmacological management of IBS-C?

Answer 7

Laxatives

• Bulk forming: psyllium
• Osmotic: PEG, lactulose
• Lubiprostone – chloride channel activator
• Linaclotide – guanylate cyclase agonist
• Prucalopride – 5HT4 receptor agonist

Question 8

What is the pharmacological management of abdominal pain and bloating?

Answer 8

• Antispasmodics: buscopan, peppermint oil
• Antidepressants: TCA, SSRI, CBT
• Antibiotics: NOT ROUTINE
• Probiotics: lactobacillus, bildobacterium